Kaiser Permanente Medicare Plans Review
Kaiser Permanente Medicare plans can include Medicare Advantage plans (also called Medicare health plans, or Medicare Part C) and Medicare Part D prescription drug plans. Learn more about Kaiser Permanente and the Medicare health plans that may be available where you live.
Kaiser Permanente is fairly popular among Medicare beneficiaries. In fact, 7% of all Medicare Advantage plan beneficiaries are members of a Kaiser Permanente Medicare plan.1
Kaiser offers a number of Medicare Advantage plans – also known as Medicare health plans or Medicare Part C – and they offer some Medicare Part D prescription drug plan options. Below is an review of Kaiser Permanente Medicare plans, including the types of plans they sell, the markets in which you might find them and the benefits they offer.
Kaiser Permanente has been a leader in health care innovation since 1945. What began as a health care program for shipyard and steel mill workers now serves around 12 million members in eight states and the District of Columbia.
Headquartered in Oakland, CA, Kaiser Permanente is among the nation’s largest not-for-profit health plans and reported revenue of more than $88 billion in 2020. There are 39 Kaiser Permanente hospitals and 723 medical offices employing more than 217,000 doctors, nurses and other workers.
Kaiser Permanente offers Medicare plans in the following areas:
- District of Columbia
Plan selection will vary within each location, and each type of Kaiser Permanente Medicare plan may not be available where you live.
Medicare Advantage is an alternative way to receive Original Medicare (Medicare Part A and Part B) benefits, and many Medicare Advantage plans may offer benefits not found in Original Medicare such as dental, vision, prescription drugs, hearing and more.
Kaiser Permanente offers a variety of HMO (Health Maintenance Organization) plans in some parts of the country, which they call their “Senior Advantage” plan. An HMO plan typically allows you to enjoy significant cost-savings when you see a health care provider that is among your plan’s network of participating providers. You will usually select a primary care physician (PCP) who will help to coordinate your care within the plan’s network and give you referrals to visit with specialists when you need specialized care.
Some of the features you may find in a Medicare Advantage plan from Kaiser Permanente (depending on your plan) can include:
- Monthly premiums as low as $0
- No annual deductibles
- $0 copayments for primary care doctor visits
- Fully covered telehealth services
- Full coverage of qualified preventive health services
- $0 copayments for lab work
- Dental coverage
- Vision and eyewear coverage
- Hearing aid benefits
- Prescription drug coverage
- Membership to SilverSneakers fitness classes or the Silver & Fit program – depending on where you live and the plan you join – at no extra charge. SilverSneakers and Silver & Fit are fitness programs designed specifically for seniors that are offered at thousands of gyms and community centers around the U.S.
Kaiser Permanente may offer several HMO Medicare Advantage plans in some of its markets to provide consumers with a variety of cost and coverage options. Kaiser’s Medicare Advantage plan names may include a subcategory such as standard, enhanced, silver, gold or value to reflect the various benefit levels. Plan names and selection will vary within each market.
Kaiser Medicare Advantage Plus
Kaiser Permanente offers an enhanced package called “Advantage Plus” that may be added onto one of its Medicare Advantage plans. The Advantage Plus package can give you additional dental, vision and hearing benefits that may vary by location.
Kaiser Medicare D-SNP Plans
Kaiser Permanente also offers a dual-eligible Special Needs Plan (D-SNP) in some locations. A Medicare Advantage D-SNP is a special type of Medicare Advantage plan that is available to people who are eligible for both Medicare and Medicaid (“dual eligible”) and has a package of benefits tailored to those needs. All Kaiser Medicare D-SNPs include prescription drug coverage.
Medicare Part D provides coverage for prescription medications. Kaiser Permanente offers Part D prescription drug plans in select states and counties that may include the following features:
- Deductibles and/or copayments as low as $0 for certain drugs
- Up to 90-day supplies of drugs delivered right to your home
- A Medication Therapy Management (MTM) program for members who take multiple prescription drugs
- Qualification for the Medicare Extra Help program, which provides financial assistance for Part D plan membership
In many cases, you will save money on out-of-pocket drug costs if you fill your prescriptions through a Kaiser-preferred pharmacy.
Kaiser Permanente’s Part D plans cover a wide range of drugs such as generic drugs, name brand drugs and even specialty drugs. You can review the Kaiser Permanente drug formulary for your drug plan to find out exactly which drugs are covered and how much they may cost.
Every year, Medicare evaluates plans based on a 5-star rating system. The Centers for Medicare & Medicaid Services (CMS) issues a star rating for every Medicare Advantage and Part D plan as well as for every insurance company who provides these plans.
In 2021, Kaiser Permanente Medicare health plans earned the highest possible Medicare Star Rating (5 stars) in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and the District of Columbia. Only in Washington did Kaiser receive 4.5 out of a possible 5 stars.
Kaiser Permanente annually receives the highest marks from credit rating agencies like Fitch Ratings and Standard & Poor’s. J.D. Power ranked Kaiser Permanente as having the highest level of customer satisfaction in five of the regions the company serves.
Kaiser Permanente makes it easy to find participating doctors, pharmacies and other health care providers. Kaiser Permanente has medical facilities where nearly all of your needed covered services can be found under one roof.
Does Kaiser Medicare Cover Vision?
Most of Kaiser Permanente’s Medicare Advantage plans include vision coverage which may include routine eye exams, glasses and contact lenses. In certain markets, extra vision coverage may be added under Kaiser’s Advantage Plus for an additional charge.
Does Kaiser Medicare Cover Dental?
Many Kaiser Permanente Medicare Advantage plans include dental coverage. In some markets, extra dental benefits may be added for an additional fee with Kaiser’s Advantage Plus package. Dental benefits under a Kaiser Medicare Advantage plan may include exams, teeth cleanings, fillings, dentures and more.
Those interested in a Kaiser Permanente Medicare plan can compare the Medicare Advantage plan options available where they live and – if eligible – enroll online or over the phone with the help of a licensed insurance agent.
In order to be eligible for a Kaiser Medicare plan, you must meet the eligibility requirements for those plans in addition to living within the service area of the Kaiser Permanente plan you wish to join.
For Medicare Advantage plans, you must be enrolled in Medicare Part A and Part B. To enroll in a standalone Part D plan, you need only to be enrolled in Medicare Part A.
You also must enroll during a qualified enrollment period. For Medicare Advantage and Medicare Part D, this is typically either during your Initial Enrollment Period (when you first become eligible for Medicare) or during the Annual Enrollment Period that takes place each fall (often called the fall Medicare Open Enrollment Period, from October 15 to December 7 each year).
1 Freed, M. et al. (Jan. 13, 2021). A Dozen Facts About Medicare Advantage in 2020. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020.